Published 6:38 pm, Sunday, May 8, 2016

A recent feature article in the New York Times chronicles the unfortunate fate of participants in The Biggest Loser after the spotlights dim, the TV cameras stop speeding and some time goes by. They regain the weight. Some of it, most of it, all of it, or even all of it plus some.

What the New York Times tells us, no surprise to those of us who have worked directly with severely obese patients over the years, is that failure overtakes the show participants. Those of us in these trenches have known all along that though challenging, weight loss is rarely the rate-limiting problem. Sustaining the weight loss is where most efforts fall down.

The article cites the work of Kevin Hall, a researcher at NIH and leading expert in the dynamics of energy balance. Dr. Hall’s work on energy balance has shed light on this before, and the new work apparently dials up the illumination. What it shows, in essence, is that the sequence of severe obesity followed by fairly drastic weight loss activates the body’s primitive defenses against starvation, which is, in effect, what it is experiencing. Metabolism slows, fuel efficiency is enhanced. In the context of Stone Age privations, these are highly adaptive responses, and we are likely here today only because our ancestors had them. In the context of willfully addictive junk food, and the bountiful ubiquity of it — it is a metabolic disaster.

The most welcome part of this story, and such high profile attention to the matter, is the relief it may provide the “victims,” reflected in quotes incorporated throughout the article. Our society has a shameful tendency to blame the victims of this obesity epidemic we have contrived, largely for profit. In that context, weight regain after loss with such fanfare must feel like ignominious failure. Dr. Hall’s work, and this attention to it, say loud and clear: it’s not your fault! That’s a vital message that participants and spectators alike need to hear.

But I think the Times neglects the principal implication. Severe obesity can almost always, and should almost always, be prevented in the first place. If ever an ounce of prevention was worth many pounds of cure, this is the time.

Participants on The Biggest Loser have severe obesity. Severe obesity is the fastest growing segment of the modern epidemic. A TV show can make spectator sport of a problem our culture is fomenting, but it cannot fix it.

Why? Because in our culture, food literally is willfully devised to be, for all intents and purposes, addictive. Because in a society that feigns to be cutting sugar, after cutting carbs, after cutting fat — the best available evidence suggests we never actually cut anything. We just kept adding more calories, from new varieties of junk food exploiting the current nutrient fixation. Because we lament the prevalence of obesity and its often dire complications, especially in children, but blithely continue to market multicolored marshmallows as part of a complete breakfast. We peddle soda as a source of happiness, rather than diabetes. We pretend that fruit roll-ups have anything to do with fruit. We market ever bigger pizzas, with ever more cheese in ever more places; and ever bigger burgers, with ever more bacon.

Let’s not mince words here: marketing obesity is big business, and a wide array of businesses are feeding on it. They include, but are not limited to, Big Food which profits from causing the problem; Big Pharma, which profits from treating the problem; Big Tech, which profits both from causing and combating the problem; and Big Media/Publishing, which profit from telling us about the problem in the customary manner: afflicting us when comfortable, comforting us when afflicted.

We know that obesity can be prevented, because most of history prevented it. We have seen history in fast forward in places like China, where obesity was rare just a matter of years ago, and is skyrocketing with adoption of all the cultural practices we are so adept at exporting. Salutary cultures, like those of the Blue Zones, defend both health and healthy weight, but are losing ground, too, to the relentless predations of Big Food, and Big Soda.

Dr. Hall’s work, and attention to it by the New York Times, will be a squandered opportunity if we allow ourselves to believe the implications are limited to physiology, as we keep running on profitable junk. The metabolic defenses against starvation are the same as they ever were. As we work to understand them better, we should not overlook the modern culture, all around us, that is the same as nothing in our prior history — and that exploits our native vulnerabilities for profit as a matter of routine.